i tendini estensori del piede

La dorsiflesisone del piede è prodotta da tre strutture miotendinee che attraversano anteriormente l’articolazione tibio-tarsica; dall’interno all’esterno esse sono il tendine tibiale anteriore (ATT), l’estensore lungo dell’alluces (EHL) e l’estensore lungo delle dita (EDL). Nell’82-90% dei casi si aggiunge un quarto piccolo muscolo, il peroneo terzo (PT). Tutte queste strutture, ricoperte da guaina sinoviale, sono innervate dal ramo profondo del nervo peroneale. L’apparato dei retinacoli costituisce ricopre queste strutture costituendo la loro puleggia.

Figure  Lo schema 3D rappresenta l’apparato dei reticacoli formato dal retinacolo superiore  (SER) dal retinacolo inferiore (SIER) il quale è formato dalla banda  obliqua superomediale (OSML), e la banda obliqua infero-mediale (OIML). L’apparato dei retinacoli stabilizza il tendine tibiale anteriore(ATT), l’estensore lungo dell’alluce (EHL), l’estensore lungo delle dita (EDL), ed il peroniero terzo(PT).
 

Nelle sottostanti immagini assiali RM, T1 pesate, sono visualizzabili ed indicate dalla frecce le strutture tendinee estensori del piede. Le immagini procedono da sinistra a destra dall’alto verso il basso. I tendini sono omogeneamente ipointensi (neri); le strutture nastriformi indicate dalle punte di freccia sono i retinacoli.

TENOSINOVITE DELL’ESTENSORE LUNGO DELL’ALLUCE

Tenosinovite dell’estensore lungo dell’alluce. Immagine RM assiale  T2-pesata (sinistra), coronale T2 pesata (destra ) e sagittale T2 pesata con  soppressione del grasso(inferiore). Le immagini mostrano segnale iperintenso (bianco) attorno ai tendini  espressione di raccolta fluida all’interno della giauna sinoviale e segno di  tenosinovite.
 

TENDINOSI

La tendinosi indica deposizione di tessuto fibroso e degenerazione all’interno della sostanza tendinea probabilmente dovuto a cronici insulti microtraumatici che consentono il prodursi di fenomeni riparativi. Fattori predisponenti includono l’età, , la diminuzione dell’apporto vascolare, il sovraccarico, o l’eccessivo livello di attività. Sulle immagini RM la tendinosi appare come ispessimento del tendine senza anormalità di segnale nel suo contesto. Nel tendine tibiale anteriore, il diametro corto superiore a 5 mm e fino a 3 cm mostra una sensibilità diagnostica del 90% per tendinosi. 

Tendinosidel tendine tibiale anteriore. Immagine RM assiale T1 pesata (linistra) T2 pesata (destra )Le frecce dimostrano il tendine omogeneamente ispessito ma strutturalmente integro. L’immagine coronale T2 pesata  (inferiore) conferma l’omogeneo ispessimento della porzione inferiore del tendine e l’assenza di lesioni nel suo contesto.
 

LESIONE PARZIALE

Lesione parziale del tendine tibiale anteriore. Immagine RM assiale T1 pesata (sinistra) e T2 pesata  (destra) all’altezza del cuneiforme mediale  mostrano l’assottigliamento del tendine, incremento lineare dell’intensità di segnale nell’immagine T2 pesata e l’appiattimento del tendine (frecce). L’immagine coronale T2 pesata (inferiore) conferma l’assottigliamento del tendine e l’edema peritendineo (freccia).
 

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